The 16th National Symposium of the Saudi Oto-Rhino-Laryngology society held in Abha 5-6 May 2010

Role of CT Perfusion in the Assessment of Enlarged Cervical Lymph Nodes. Initial experience M F Bazeed, MB Bch, M Sc., Ph D, W M Ghnnam, MB Bch, M Sc., Ph D1 Y Al-Khatani, MB BS, AB, SB (ORL), MD2, N Malik, MB BS, DLO (Irl), FRCS (Edin), FRCS (Glas) 2 1-Departmentof Diagnostic Radiology, Faculty of Medicine, Mansoura University, Department of General Surgery, Faculty of Medicine, Mansoura University1, 2-Department of ENT Armed Forces Hospital Southern region, KSA2 Abstract: Background: CT perfusion is a recent imaging modality which can add function information to the anatomical information gained from CT. Objective: The purpose of this study was to evaluate the capability of CT perfusion (CTP) to differentiate enlarged malignant from enlarged benign cervical lymph nodes to define the best lymph node for pathological evaluation. Material & Methods: CTP was attempted for 23 patients with clinically palpable enlarged cervical lymph nodes. Initial non contrast study was done for localization of the enlarged lymph node followed by perfusion study for 60 seconds at the same table position after injection of 40 ml intravenous contrast. Perfusion study was followed by routine post-contrast study from skull base to thoracic inlet. Post processing was done by a dedicated workstation using ipsilateral and contralteral carotid systems as arterial input vessels. Perfusion parameters blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) of the enlarged lymph nodes were generated. We compared between the perfusion parameters values obtained using ipsilateral and those obtained using contra-lateral carotid systems as well as the values of the different perfusion parameters of the different groups of enlarged lymph nodes. Results: The examined enlarged lymph nodes were 9 benign, 8 metastatic and 6 non Hodgkin lymphoma (NHL) lymph nodes. In enlarged malignant lymph nodes (metastatic + NHL) BF was significantly higher (P = 0.00091) and MTT was significantly shorter (P = 0.0050) in comparison to enlarged benign lymph nodes. In enlarged metastatic lymph nodes alone and enlarged NHL lymph nodes alone BF was significantly higher (P value = 0.0050 and 0.0051 respectively) in comparison to enlarged benign lymph nodes. On the other hand MTT of enlarged metastatic lymph nodes alone and enlarged NHL alone was shorter than those of enlarged benign lymph nodes, yet the differences was statistically significant only with NHL lymph nodes. Blood volume was relatively higher and MTT was longer in enlarged metastatic lymph nodes in comparison to enlarged NHL lymph nodes. Permeability surface showed non significant differences between all the three groups of enlarged lymph nodes. Conclusion: Computed tomography perfusion parameters added useful functional information to the anatomical and morphological criteria obtained by conventional CT studies helping in differentiating benign from malignant lymph nodes. Computed tomography perfusion provided valuable data about the most suitable lymph node for biopsy. Management outcome of laryngeal contact granuloma: Pharmacologic versus pharmacologic and voice therapy. Tariq Al-Aidarous. Ali Abouloyoun. Hassan Bukhari. *Consultant and HOD Otorhinolaryngology, Head & Neck surgery. ** Consultant Phoniatrics ***Consultant Gestroentrology, Al-Noor Specialist Hospital, Makkah, KSA Dr. Tariq Al Aidarous phoniatric unit - ENT department, Al-Noor Hospitaling Abdullah Medical city Makkah, Saudi arabia, P.O Box 4454, Email: address: Tariq ent [email protected] Tel. 00966/555514166. Abstract: Objective: The aims of this study was to compare the management outcome of contact granuloma by Omeperazole with the combination of Omeperazole and voice therapy. Methodology: Twenty two patients were diagnosed as contact granuloma in the Phoniatric unit, ENT department at Al-Noor Specialist Hospital Makkah, Saudi Arabia from January 2006 to December 2008. Patients were subjected to voice evaluation, and laryngeal examination followed by upper GIT endoscopy. Subjects were divided into group A [8] and group B [10], after exclusion of 4 patients with negative GERD on endoscopy. Group A and B were given Omeprazole and Omeprazol with voice therapy, respectively. Descriptive analysis and student's t-Test was done for continuous data while Z-test was applied to categorical data. P value < 0.05 was considered significant. Results: All subjects with mean age of group A (32.5 + 8.8years) and group B (39.5 + 10.1 years) (p > 0.5). Dysphonia was common presenting symptom, in group A 4(50%) and 6(60%) in group B. Recurrent history in group A was voice misuse 6(75%) while in group B was spirits intake 6(60%) and hyperacidity & reflux 6(60%). Major presented phonesthenic symptom was frequent throat clearing in both groups, 8(100%) group A and 9(90%) group B. Thirteen (59%) had GERD with hiatus hernia on upper GIT endoscopy. In group B almost all 10(100%) subjects cured as compared to group A 5(63%) (p< 0.001). Conclusion: Contact granuloma has strong relation with GERD which could be managed better with the combination of proton pump inhibitor and voice therapy. Key Words: Gastro-Esophageal Reflux Diseases, Contact Granuloma, Omeperazol, Voice Therapy Thyroid bed surgery for recurrent and persistent well differentiated thyroid carcinoma: safety and surgical strategy Al-Garni Mohammed, Al-Shaikhi Ibraheem, Al-Zahrani Rajab Otorhinolaryngology Head And Neck Surgery Department, King Abdul Aziz Medical City, Jeddah, Saudia Arabia Abstract Introduction: Well differentiated thyroid carcinoma is usually treated with total thyroidectomy and iodine ablation. espite this aggressive protocol there is low but definite risk for recurrent or persistent disease. Treatment of this entity is by reoperation and iodine ablation. Reoperation is usually associated with higher risk of complications. The aim of this study was to present a sound surgical strategy aiming to minimize the morbidities and achieve oncological safety, based on a sound multidisciplinary clinical judgment. Design: Retrospective charts review at one tertiary care institute from January 2006 ntil January 2010. Method: All patient who were diagnosed with well differentiated thyroid carcinoma after total thyroidecto-my and had recurrent or persistent disease based clinical examination, thyroid scan and ultrasound of the thyroid bed with elevated thyroglobulin level were included in the study. All of them had thyroid bed surgery in the form of either unilateral or bilateral neck exploration. In all of them we applied the back door technique for identifying the recurrent laryngeal nerve and the parathyroid gland and we used monitoring of the nerve in interrupted manner. Frozen section was done in some of the case where the mass was small (between 1.5 to 1 cm). CT scan was also used as adjunctive tool aiming for two reasons. First, to exactly localize the mass and second, to screen the neck for metastasis. Result: Seventeen patients were identified. All of them were females with a median age of 46 years. In all of them we had a histopathological confirmation of thyroid tissue and one had negative exploration. The average tissue removed is 1.4 cm. Tow patient had recurrent laryngeal nerve palsy preoperatively one only had post operative recurrent laryngeal nerve palsy (6%). One patient developed hypocalcaemia(6%). None of them developed hematoma or wound complications. One patient had another recurrence at the superior mediastenal lymph node and reoperated again with no complication. Conclusion: treatment of recurrent thyroid carcinoma represent complex challenge to the head and neck surgeon and has to be done in multidisciplinary team approach that include the surgeon, endocrinologist and the radiologist. Minimal morbidity of this surgery can be achieved if sound and systematic approach has been applied Tonsillar Fossa Closure: A Quest in Tonsillectomy Pain Reduction Sendi Khalil S, FRCSC, FACS * Amry Saleh, MD,** Zawawi Faisal T., MBBS,* Alnoury Ibrahim,* MBBS, Al-Radadi Abeer, MD* *Department of Otolaryngology, Head and Neck Surgery King Abdulaziz University, Jeddah, Saudi Arabia **Department of Ear, Nose and Throat King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia Abstract. Objectives: To study if suturing the tonsillar pillars to close the tonsillar fossa after excision is beneficial to reduce post tonsillectomy pain. Materials and Methods: A prospective randomized double blinded study Thirty six patients who had tonsillectomy in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, had one side the pillars sutured on one side and the other side was left un-sutured (control). The patient was asked to compare pain between both sides. Results: The mean age was 14.2 (range 7-36), males 44.4% (n = 16), females 55.6% (n = 20). Pain was reduced in the site of the stitch in 55.6% (n = 20), and was increased in 22.2% (n = 8), but did not change in 22.2% (n = 8). Conclusion: Reduction in pain was observed at the site of the suture, especially in children. This theory needs further exploration with a larger population. Management of obstructive sleep apnea, paradigm shift. Al-Abdulwahed S. FRCSC King Faisal specialist Hospital and research center Jeddah - Saudi Arabia Email: [email protected] Purpose of the study: to change the current concept of managing obstructive sleep apnea(OSA) Design and method of study and analysis: review of randomized control articles. Appraisal of the methodology and outcome. Summary of results: the articles reviewed show the short coming of the current support for the use of sleep study as a gold standard for investigating a patient with OSA. Likewise, there is no evidence that CPAP should be the standard of care. Conclusions: according to the papers reviewed, surgery should be the first line in the management of OSA. Study of Dead Regions in the Cochlea: New insight for management of Auditory Neuropathy/Dys-Synchrony Kamal, N.* Shalaby, A.*, ABUL-NASR, K.# El-Kholi, W.* Soha Mekky** Taha T.* Helal, D.* * Audiology Unit, Otolaryngology Dept. Ain Shams University **Audiology Unit, Otolaryngology Dept. Zagazig Universit # Audiology Otolaryngology Dept. Saudi German Hospitals, Abstract Objectives: This research was done to investigate dead regions of the cochlea in Auditory Neuropathy/Dys-xssynchrony (AN/AD) patients and how much their presence affects the benefit from hearing aids. Material and Methods: Twenty adolescent and adult patients with Auditory Neuropathy/Dys-synchrony (AN/AD) together with a control group of forty age-matched patients with SNHL were examined. Both groups were evaluated for the presence of dead regions of the cochlea by TEN-HL test (Moore et al., 2004) [1]. TEN-HL test demonstrated positive criteria in 95% of ears in AN/AD patients which was mainly at low frequency bands, while 15% had positive TEN-HL test across all the tested frequency range. On the contrary, SNHL patients showed positive TEN-HL test in 16.5% of examined ears mainly in the mid frequency bands. The number of dead regions was negatively correlated to speech recognition. Results: Open hearing aid fitting was tried in AN/AD patients aiming to minimize the masking produced by low frequency dead regions and emphasize the high frequency components of speech. Binaural open hearing aid fitting showed improvement in high frequency detection thresholds that was significantly better than monaural fitting. Benefit from amplification was negatively correlated to the number of dead regions in TEN-HL test. Training of AN/AD patients on the use of these high frequency cues was suggested. Conslusion: Diagnosis of dead regions can be taken as a guide in hearing aid fitting as well as in cochlear implant programming. Key Words: Auditory Neuropathy/Dys-synchrony, cochlear dead regions, TEN-HL test, Open hearing aid fitting. The effect of prolonged use of Mobile phone on auditory system Al Sanosi Abdulrahman Shami Ibrahim Saber Osama Al habeeb Salman Hagr Abdulrhaman. Department of Otolaryngology, King Abdulaziz University Hospital [email protected]/[email protected]. P. O. Box 245, Riyadh 11411, Saudi Arabia. Abstract Objective: the aim of the study was to assess potential changes in hearing function as a consequence of prolonged exposure to mobile phones as determined by changes in distortion product otoacoustic emission (DPOAE) and hearing threshold levels on pure tone audiogram (PTA). Methods: This prospective control study was performed on sixty three volunteers. Pure tone audiometry (PTA) was recorded before and immediately after 60 minutes exposure of the same model mobile phones. Questionnaires have been filled up by the volunteers including symptoms they experienced after using the mobile phone. Results: Hotness / pain were the most commonly reported by the participants. There was a significant difference between pre and post (1000, 2000, average) on PTA in the tested ear. There was no significant difference between pre and post DPOAE in the tested and control ears (p>0.05). Conclusion: It could be concluded that a 60-min close exposure of EMFs emitted from a mobile phone had an immediate after-effect on measurements of HTL of PTA in young human subjects and can cause other otologic symptoms. Screening for Noise Induced Hearing LossAmong Military Personnel In Eastern Province Of Saudi Arabia Col. Dr. Saud Al-Saif Dr. Mohamed M Abdeltawwab Abstract Objective: To study the effect of noise exposure on hearing sensitivity of the screened study group, analysis of questionnaire for noise exposure and to compare hearing impairment results among different noise exposure categories. Materials and Methods: As a first part of the screening study, 1879 subjects were evaluated. They were 860 from land forces, 358 air force, 378 air defense forces and 283 from the navy. First noise exposure survey was conducted by the study group. Then screening air conduction pure tone audiogram was done for each participant. Patient who did not pass the screening air conduction pure tone audiogram were referred to the ENT and audiology unit of KFMMC for further evaluation. Complete history, otological examination, and tympanometry measurement were done. Results: The average duration of duty for the study group was 10.26 ± 8.06 years. Cigarette smoking was observed in 33.9 % of the study group. In this study, 10% (188 subjects out of 1879) did not pass the screening air conduction pure tone audiogram and they were referred to the audiology clinic. Discussion and Conclusion: Ten per cent of the high-risk noise exposed screened subjects had high frequencies hearing loss. This hearing loss could be minimized with the proper use of the hearing protective devices on exposure to intense noise level. We conclude from this study that as noise induced hearing loss is a preventable disease, the proper use of the hearing protective devices should be encourage to avoid NIHL. Systemic Absorption of Topical Gentamicin Sinus Irrigation Kevin K. Wong, MD, Osama Marglani, MD, FRCSC, Brian D. Westerberg, MD, MHSc, FRCSC, Amin R. Javer, MD, FRCSC Presenting author: Dr Osama Margalani MD, FRCSC Consultant Otolaryngology, Head and neck Surgery Canadian board, University of Ottawa, Canada Fellowship in Rhinology, Endoscopic Sinus and Base of Skull Surgery University of British Columbia, Vancouver, Canada Faculty member of Umm Al-Qura University-Medical School e-mail [email protected] address P.O.box 3655, jeddah 21841. Abstract Objective: Evidence surrounding systemic absorption of gentamicin during intraoperative of the is The of this study were to if gentamicin is from the if hearing loss of and if gentamicin the up the auditory to the ear. Design: prospective case Methods: A of patients surgery were identified. gentamicin was used to the using a was performed minutes gentamicin levels and at minutes and change in average and threshold at 8 Results: Twenty patients were levels were in three was not in the significant hearing loss was observed in of the Conclusions: Gentamicin be from the during intraoperative of the levels were well The clinical of this further study to if with gentamicin is a hearing aid experience in Saudi Arabia MBBS,* Abdulrahman Hagr FRCS Abdulrahman Otolaryngology Department, King Abdulaziz University Hospital Saudi Arabia. King Saud University, Otolaryngology & Skull base King Abdulaziz University Hospital Saudi Arabia. King Saud University, Otolaryngology & Skull Base of cochlear implant King Abdulaziz University Hospital & Saudi Arabia. Abstract The aim of study was to review experience with the first hearing aid Introduction: The hearing aid an method of treatment for patients with hearing loss and side has to the of in Saudi Arabia have as a method of we to present experience as the first in Saudi Arabia. Methods: A study review of first patients with between 2006 and We recorded for and post surgery were evaluated in a Results: Ten patients were females and Patients had either with using hearing aid or hearing loss. improvement in were The mean of improvement of air conduction among all patients after using was post fitting were as Conclusion: results showed that experience with these patients have a outcome in their and Abdulrahman King Saud University, Otolaryngology & Skull base surgeon King Abdulaziz University Hospital Saudi Arabia author: Abdulrahman Hagr Department of Otolaryngology of unit King Abdulaziz University Hospital, P. O. Box 245, Riyadh Saudi Arabia. Abstract Objective: The aim of this study was to review experience with cochlear implant in hearing loss bilateral Methods: charts Results: ears of of hearing loss bilateral who had cochlear were All patients had and non of them had experienced nerve All patients of their two of them had bilateral implant to their Conclusions: This is one of the we can conclude that cochlear implant should be considered for patients with hearing loss bilateral We bilateral cochlear implant for patient with bilateral and to their benefit from cochlear hearing cochlear Auditory Dr Consultant King Fahad Medical City, [email protected]. Dr. Abdulrahman - King Saud University Otolaryngology & Skull Base of cochlear implant King Abdulaziz University Hospital & [email protected] Abstract Objective: to approach and experience with a of auditory tertiary care and Methods: a review of patients who were diagnosed and managed at of patients diagnosed with hearing loss compared to 10% average and in the age 1 to 4 in the age Hearing loss from to unilateral cochlear were compared to of function Results: and auditory with of the nerve in the presence of auditory Hearing detection of sound in have been of benefit in to speech and a management Conclusion: Auditory a challenge for and The purpose of this study was to the of this cause of hearing the and management experience with these The effect of prolonged use of Mobile phone on auditory system Al Sanosi Abdulrahman Shami Ibrahim Saber Osama Al habeeb Salman Hagr Abdulrhaman. Department of Otolaryngology, King Abdulaziz University Hospital [email protected] / [email protected] P. O. Box Riyadh Saudi Arabia Abstract Objective: the aim of the study was to assess potential changes in hearing function as a consequence of prolonged exposure to mobile phones as determined by changes in distortion product otoacoustic emission (DPOAE) and hearing threshold levels on pure tone audiogram (PTA). Methods: This prospective control study was performed on sixty three volunteers. Pure tone audiometry (PTA) was recorded before and immediately after 60 minutes exposure of the same model mobile phones. Questionnaires have been filled up by the volunteers including symptoms they experienced after using the mobile phone. Results: Hotness / pain were the most commonly reported by the participants. There was a significant difference between pre and post (1000, 2000, average) on PTA in the tested ear. There was no significant difference between pre and post DPOAE in the tested and control ears (p>0.05). Conclusion: It could be concluded that a 60-min close exposure of EMFs emitted from a mobile phone had an immediate after-effect on measurements of HTL of PTA in young human subjects and can cause other otologic symptoms. no ENT King Fahad Military Hospital, Jeddah, Saudi Arabia, - Email: [email protected]. Introduction: is a well to all It is the surgical to the or Material & Method: to of were done All had in with no be in in the Results: patients had the of with no years. There were All were performed Pain was Patient was after surgery as a case - This a surgical It can be used with of or and no is Patient is on the same Patient is in for and after to Conclusion: This is for surgeon and pain. post operative no post operative to Patient is Patient is on the same This can be used with other as or or Patient is of this technique of no pain.

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